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How the Five Elements Theory Can Help You Still, what does this talk about elements have to do with your health? Each of the five elements represents two of the ten main organs in the human body.

Wood represents the liver and the gallbladder. Fire is associated with the heart and the small intestine. Earth corresponds to the spleen and the stomach. Water represents the kidneys and the bladder. The last element, metal, represents the lungs and the large intestine. These relationships between the elements and the organs are how Oriental medicine practitioners envision our organs acting and interacting.

Ask the average person walking down the street, and they probably won’t know where their kidneys are, or how they help their body function. But centuries ago, the vast majority of Chinese people understood all of this vital information because they had these simple images related directly to what they saw in nature. These images give a concrete expression to how our body, as complicated an organism as it is, works. For example: we all know that wood feeds fire. By now, we also know that wood is the element associated with the liver and gallbladder. While fire represents the heart and the small intestine. Medical facts have established that a healthy liver (wood) plays an extremely important role in the heart’s (fire) ability to pump blood throughout the body. Thus: wood feeds fire, and the liver “feeds” the heart. Still, elements can have the opposite effect on one another. For instance, fire can melt metal. A damaged heart (fire) has been shown to slow down the lungs (metal) because it no longer pumps blood fast enough to fill all the alveoli that transfer oxygen into it.

The strong links between all the organs provide connections that the practitioners of Western medicine don’t pay proper attention to. For instance, diseases and ailments in some organs can show up as clear signs in other organs as well. Simply by taking note of how organs are functioning, Oriental practitioners are able to diagnose complicated organ imbalances which may lead to a much more serious disease.

Because Oriental practitioners use the Five Elements theory as a basis for looking at organs as interconnecting parts of one whole, it is important to observe the roles assigned to each organ. While many of the following descriptions will be familiar to you, there are some additional characteristics here that I always take into account when I treat my patients

With the number of babies born through in vitro fertilization at an all-time high, some doctors are trying an alternative that potentially could be less expensive and less taxing on a woman’s body.

Some fertility clinics are offering a gentler version of IVF that uses fewer, milder drugs and requires less frequent medical visits.

Success rates aren’t well established. The American Society for Reproductive Medicine says pregnancy rates from minimal-stimulation IVF are likely to be lower than with traditional IVF. Indeed, if the milder kind doesn’t succeed and women return for additional cycles, the cost can quickly approach or exceed traditional IVF, some doctors say.

For the first time, the organization that publishes clinics’ success rates, the Society for Assisted Reproductive Technology says it will break out success rates for minimal-stimulation cycles in its 2014 statistics, which will be released in 2016. The odds of successfully having a baby after any form of IVF averaged about 37% per cycle in 2012. The odds vary by factors including a woman’s age and the number of eggs retrieved.

Babies conceived using IVF made up 1.5% of all births in 2012, according to the ASRM. Those bundles of joy come at a cost–an average of $12,400 per IVF cycle not including drugs that can add thousands more. Insurance coverage varies.

In general, the cost of minimal stimulation could be 50% to 60% of the cost of a full stimulation cycle, says Suheil Muasher, a reproductive endocrinologist at the Duke Fertility Center in Durham, N.C.

In conventional IVF, a woman typically is prescribed injectable drugs to stimulate her ovaries to make more eggs than they would without medication. Eggs are harvested, combined with sperm in a laboratory and the embryos later transferred into a woman’s uterus in the hopes they’ll successfully produce a pregnancy.

There is no universal definition for mild or minimal-stimulation IVF. Terminology developed by the International Society for Mild Approaches in Assisted Reproduction defines it as a protocol consisting of milder doses of injectable drugs, oral drugs or a combination of both that aims for the collection of two to seven eggs, based on published research. Conventional IVF aims for more eggs.

The minimal approach requires fewer doctor visits for blood work and ultrasound monitoring. The medication savings from this approach can be between $3,000 and $8,000, says Dr. Muasher. “It’s more patient-friendly, it’s less costly and for some patients it has fewer complications,” he says.

Proponents say it is a particularly good option for patients who have a very strong response to fertility drugs and are at high risk of ovarian hyperstimulation syndrome, a potentially dangerous complication. Women can be at high risk due to previous IVF history or risk factors like polycystic ovary syndrome or being young with irregular cycles.

They also say it is an alternative for women, including many older ones, who produce just a few eggs in response to drugs, regardless of the dose. It is also appropriate for women who don’t want to be faced with a decision about what to do with embryos they don’t use.

Neeburbunn Lewis, a 35-year-old nurse living near Portland, Maine, and her husband spent between $20,000 and $25,000 for the single cycle of conventional IVF that produced her first child. When the couple wanted a second child, “financially, going through another cycle was not feasible,” she says. She also experienced ovarian overstimulation that put her in the hospital when she went through IVF. “I could not put my body through that again,” she says. She heard about minimal-stimulation IVF from her OB-GYN and did one cycle at the Maine location of Boston IVF. Her cost this time: $5,000. She is eight months pregnant with her second child.

Ms. Lewis’s reproductive endocrinologist, Benjamin Lannon, says he sees minimal-stimulation IVF as an option “where cost is the primary barrier” to access. But patients need to understand their chances of getting pregnant per cycle are lower than with conventional stimulation, he says.

To perform a milder course of IVF, Sherman Silber, director of the Infertility Center of St. Louis, uses an inexpensive oral drug and low, infrequent doses of injectable drugs to stimulate women to produce only a modest amount of eggs at one time, which he says increases their average quality. In some cases, if enough embryos aren’t produced in one cycle, they are frozen and the cycle is repeated until there are several more embryos to transfer.

Dr. Silber’s research, presented at the October ASRM meeting, found it was more effective, with a higher pregnancy rate per egg, and less expensive than traditional IVF for women 40 and older and for women with low ovarian reserve. Dr. Silber is preparing to submit his data to a peer-reviewed journal.

Still, the likelihood of needing to repeat minimal-stimulation IVF for success has some doctors concerned. “I would argue that the evidence speaks against it,” says Norbert Gleicher, medical director of the Center for Human Reproduction, a fertility center in New York. He was an author of a 2012 study published in Reproductive BioMedicine Online that compared 14 women under age 38, with normal ovarian function who underwent low-intensity IVF to 14 who had regular IVF. The low-intensity regimen “reduced pregnancy chances without demonstrating cost advantages,” the study found. Dr. Gleicher is now trying to get funding for a randomized trial to compare the two approaches.

Zev Rosenwaks, director of the New York-Presbyterian/Weill Cornell Medical Center for Reproductive Medicine, says while minimal stimulation might work for some women, his own experience suggests that moderate stimulation–with nine or 10 eggs as the ideal and using the lowest dose of drugs possible–produces the most success with the lowest risk of complications. He says he has seen “too many [women] to count” who have tried and failed with minimal stimulation at other clinics.

In 2012, IVF procedures and babies born using IVF reached an all-time high, according to a report by the Society for Assisted Reproductive Technology of its 379 member clinics.

165,172 procedures involving IVF
61,740 babies born using IVF
1.5% of all U.S. births were IVF births
Credit: Katherine Hobson

Babies born to women who exercised during pregnancy have enhanced brain development compared with babies born to moms who didn’t exercise while they were pregnant, a new Canadian study suggests.

The babies of 10 women who did as little as 20 minutes of moderate exercise three times a week during pregnancy showed more advanced brain activity when they were tested at eight to 12 days old than the babies of eight women who did not exercise during pregnancy, reported University of Montreal researcher David Ellemberg and his colleagues at the Neuroscience 2013 conference in San Diego on Sunday.

“We are optimistic that this will encourage women to change their health habits, given that the simple act of exercising during pregnancy could make a difference for their child’s future,” Ellemberg said in a statement.

The women in the study were randomly assigned to an exercise group or a sedentary group at the beginning of their second trimester. Those in the exercise group had to spend at least 20 minutes three times a week doing exercise intense enough to lead to at least a slight shortness of breath.

After their babies were born, the researchers tested them by placing a cap of electrodes on the babies’ heads and then playing novel sounds while they slept. They measured the electrical response of the babies’ brains to see how well they could distinguish between different sounds. The researchers found that the babies in the exercise group produced signals associated with more mature brains.

The researchers said they plan to test the children’s cognitive, motor and language development at age one to see if there are lasting effects.

Although women in the past have been told to rest during pregnancy, exercise is now recommended for pregnant women because it has been shown to reduce the risk of complications during pregnancy and can help a woman recover more quickly after giving birth.

Ellemberg has previously researched how exercise affects children’s brain development. He said he was inspired to see how a mother’s exercise during pregnancy affected her baby’s brain after reading studies that showed baby rats performed better on memory tasks if their mothers exercised during pregnancy.

By John M. Grohol, Psy.D.
A study recently published in PLoS Medicine suggests a surprising new treatment for even severe depression — acupuncture. Yes, acupuncture.In this randomized U.K. clinical trial, primary care subjects who received a protocol of acupuncture did even better than those who received a form of humanistic counseling for the treatment of depression.

So if all else has failed for depression, should you give acupuncture a go

The new study (MacPherson et al. 2013) examined 755 depressed patients in the U.K. who visited their primary care physician and scored high on a depression measure. They were then divided into three treatment groups — acupuncture treatment, humanistic counseling, or usual care. The outcome measure was the Patient Health Questionnaire (PHQ-9) scores at 3 months with secondary analyses over 12 months follow-up. At 3 months, 614 patients were measured, and at 12 months, 572 patients were measured. The majority of patients, nearly 69 percent, were taking antidepressant medications at the start of the study.
At the 3-month time period, 33 percent of those who underwent acupuncture improved more than 50 percent on their depression score, compared to 29 percent of the humanistic counseling group. This was not a statistically significant different, demonstrating, in effect, that these two groups were largely the same.

However, since the researchers also continued measuring depression further out — at 9 and 12 months — they found something else, too. The usual care group “catches up” with the two other treatment groups, so that all interventions look about the same:

The scores in the usual care group continued to reduce over time, such that differences were no longer statistically significant at 9 and 12 months. There was no evidence of significant differences between acupuncture and counselling throughout.
This reinforces the fact that time itself helps “treat” many mental health concerns, including depression.

The only problem I have with this study — not described in the limitations section of the research — is that humanistic counseling isn’t known as a robust, well-proven treatment method for clinical depression. There simply isn’t a lot of supporting research for this particular form of talk therapy, as compared to cognitive-behavioral approaches.

Counseling is typically humanistic, following the teachings of Carl Rogers. The researchers describe it as “a “talking therapy” that provides patients with a safe, non-judgmental place to express feelings and emotions and that helps them recognize their capacity for growth and fulfillment.”

The researchers do not offer a whole lot of rationale for choosing humanistic counseling, which is more popularly practiced in the U.K., over CBT:

A widely used intervention for patients with depression is counselling, which is provided in approximately half of the 9,000 primary care practices in England. Most counsellors provide a humanistic style of counselling. Recent National Institute for Health and Care Excellence (NICE) guidance is equivocal in recommending counselling for mild to moderate depression, identifying uncertainty regarding its effectiveness.

So the researchers acknowledge up-front that this form of counseling they’ve chosen isn’t even reliably recommended for “mild to moderate” depression — with but they’re actually going to compare using it on subjects with “moderate-to-severe” depression.1

What they’ve demonstrated is that there is a significant difference between usual care from your primary care physician and one of these two types of intervention — either acupuncture or counseling. Something in addition to taking antidepressants seems to make you feel better and resolve depression symptoms faster than nothing at all. But after 9 and 12 months… all groups looked the same. So if you want to feel better, faster, you might try acupuncture for depression (but it may not be any cheaper than seeing a therapist).2

After 12 months, 56.5 percent of the subjects were still taking antidepressants, down just over 12 percent from the start. Which is probably a more telling statistic than anything else the researchers found.

Read our news article about the study: Acupuncture Works Just as Well as Counseling for Depression

National Collaborating Centre for Mental Health (2010) The NICE guideline on the treatment and management of depression in adults: 1–707.

Footnotes:

In fact, the NICE guidelines are pretty clear: “Overall the evidence for counselling [in the treatment of depression] is very limited.” And in reading the NICE document (2010), they actually found very little support for counseling as a treatment intervention, especially when you look at how patients are doing at the 6- or 12-month mark.

Depending on where you live, acupuncture may or may not be cheaper than counseling or therapy. But unlike psychotherapy, most insurance companies won’t cover your acupuncture treatments.

Military doctors in Afghanistan are using acupuncture to treat brain injuries, with promising results
Bryan Denton for the Wall Street Journal

Marine Lance Cpl. Tristan Bell was injured in a jarring explosion that tore apart his armored vehicle, slammed a heavy radio into the back of his head and left him tortured by dizziness, insomnia, headaches and nightmares.
He is recovering on a padded table at Camp Leatherneck, Afghanistan, beneath strings of soft, white Christmas lights, with the dulcet notes of “Tao of Healing” playing on an iPod and a forest of acupuncture needles sprouting from his head, ear, hands and feet.
In a bit of battlefield improvisation, the Navy is experimenting with acupuncture and soothing atmospherics to treat Marines suffering from mild cases of traumatic brain injury, commonly called concussions—the most prevalent wound of the Afghan war.

After hitting on the idea in late November, Cmdr. Keith Stuessi used acupuncture, along with the music and lights, to treat more than 20 patients suffering from mild brain injuries. All but two or three saw marked improvements, including easier sleep, reduced anxiety and fewer headaches, he says. Cmdr. Earl Frantz, who replaced Cmdr. Stuessi at Camp Leatherneck last month, has taken charge of the acupuncture project and treated 28 more concussion patients.
“I think a couple years down the road, this will be standard care,” predicts Cmdr. Stuessi, a sports-medicine specialist turned acupuncture acolyte. “At some point you have to drink the Kool-Aid, and I have drunk the Kool-Aid.”

While researchers are still investigating how exactly it works, studies have found that acupuncture can help relieve pain, stress and a range of other conditions. The newest Defense Department and Department of Veterans Affairs clinical guidelines recommend acupuncture as a supplementary therapy for post-traumatic stress disorder, pain, anxiety and sleeplessness.
The VA is recruiting candidates for a study of acupuncture’s effectiveness in treating PTSD and traumatic brain injury. Based on other studies of its benefits, “there is good reason to believe that acupuncture will induce recovery across a number of trauma spectrum dysfunctions in patients with TBI and PTSD, at low cost and with little risk,” the VA wrote.

In 2008, the Navy put Cmdr. Stuessi, a 44-year-old from Wales, Wis., and a handful of other doctors through a 300-hour acupuncture course. When he came to Afghanistan in August to create a clinic to treat concussions and minor physical injuries, the commander brought his collapsible needling table. He expected to use it for the usual array of sprained ankles and sore backs.

Once at Camp Leatherneck, though, Cmdr. Stuessi stumbled across an article about using acupuncture to treat PTSD and realized many of the symptoms overlapped with those of mild traumatic brain injury: insomnia, headache, memory deficit, attention deficit, irritability and anxiety.
Lance Cpl. Bell, 22, from Billings, Mont., was patrolling a ridgeline in mid-January when the Marines in his vehicle spotted a half-buried bomb in the road ahead. They backed up onto a second booby-trap, leaving five of the seven crewmen, including Lance Cpl. Bell, unconscious. He took medicine, but the headaches and insomnia grew relentless as the days passed. “If I took a nap, I’d have nightmares and crazy dreams,” he says. “I don’t take naps.”

He was waiting to see his regular doctor when Cmdr. Stuessi invited him to watch another Marine get acupuncture. The lance corporal hates needles, but he was getting desperate. The back of his head throbbed so hard it made his eyes hurt. “I thought, ‘Something has to change here—I want to get back out there,’ ” he recalls.
The night after his first session, he slept eight hours, twice what he had managed before. Soon he was returning eagerly every three days, when the benefits began to fade. He made a recent visit after a bad night, in which he woke up disoriented, headed out for a smoke and hit his head on the bunk bed.

When Lance Cpl. Bell showed up at Cmdr. Stuessi’s plywood office in a green Marine Corps sweatshirt and camouflage pants, the doctor turned off the overhead fluorescent light and switched on a string of Christmas lights his wife had shipped him. He shuffled his iPod from “Mack the Knife” to the flute notes of his healing music.
He slipped one needle into the top of the Marine’s head, and more into his left ear and hands. As he worked, he spoke softly of “chi,” which he described as the rush of numbness or warmth when the needle hits the spot, and “shen men,” a point in the ear connected to anxiety and stress. “This is Liver Three,” he said, sliding a needle into Lance Cpl. Bell’s left foot and moving it until the Marine felt the desired effect.

A 2008 RAND Corp. study found that one in five troops who serve in Iraq or Afghanistan suffers traumatic brain injury, ranging from severe head wounds to more common concussions. Standard treatment for the latter can involve painkillers, antianxiety medication, sleeping pills, counseling and group therapy.
Acupuncture immediately appeared to speed recovery, Cmdr. Stuessi says. His first patient, unable to sleep more than four hours a night despite two weeks of standard treatment, put in 10 hours the night after his initial needling. Most other patients have seen similar results.

Lance Cpl. Dominic Collins, who shared a vehicle with Lance Cpl. Bell, was plagued by headaches after the bombing. One night in February, he dreamed he was being mortared. He rolled out of his bunk to take cover.
He declined the clinic’s offer of acupuncture. “It’s kind of not my thing,” he says. “I have tattoos, but it’s the idea of getting stuck” that puts him off.

One Marine tried jokingly to discourage Cpl. Francisco Sanchez, who hit two mines in one day, from using acupuncture by making him sit through an action movie in which the hero stabs the villain with a needle in the back of the neck. The villain’s eyes bleed. Then he dies.
But word has spread around camp, and Marines with everything from job stress to snuff addiction now plead for acupuncture.
“All we can say is we’ve learned from the Chinese on this,” Cmdr. Stuessi says. “They’ve been doing this for a couple thousand years.”

Acupuncture may be an effective way of easing severe period pain, a South Korean review of 27 studies suggests.

Researchers said there was “promising evidence” for acupuncture in treating cramps, but that more work was needed.

In the British Journal of Obstetrics and Gynaecology, they noted two studies found little difference between real and sham acupuncture in treating pain.
Acupuncture is a less contentious form of complementary medicine than some, but its value is still disputed.
Period pain can be severe in some women and may be accompanied by nausea, diarrhoea, migraine and backache. Common treatments include pain killers, applying heat and exercise – although a recent study questioned the efficacy of the latter.

This latest review involved 27 studies – which included nearly 3,000 women. They addressed a variety of forms of acupuncture – from classical to acupoint injection.
Traditional acupuncturists insert needles in acupuncture points located along what they describe as “energy meridians” – a concept for which many scientists say there is no evidence. Sham acupuncture places needles away from these points.
It is not clear whether either form alleviates pain as a result of the placebo effect – the very ritual of undergoing acupuncture – or cause subtle changes in the nervous system and brain activity which can be beneficial.

“Complementary therapies should not be used exclusively, at the expense of conventional treatment, unless significant improvements have been made and your doctor tells you otherwise”
Professor Philip Steer BJOG

Nice backs needles

The analysis by the team from Kyung Hee Medical Centre found that patients with severe period pain reported a greater reduction in their symptoms when using acupuncture compared with pharmacological treatments.

But they stressed there were methodological flaws in some studies, and that the findings did need to be interpreted with caution. Nevertheless, there was “promising evidence”, they wrote.

In the UK, the National Institute for Health and Clinical Excellence (Nice) has backed the use of acupuncture in the treatment of low back pain – a move welcomed by some but criticised by those who say there is little evidence for its efficacy.

The editor-in-chief of the BJOG, Professor Philip Steer, noted that some women had period pain, also known as primary dysmenorrhoea, so badly they were “unable to function normally”.

“Women with primary dysmenorrhoea should consult their GPs or gynaecologists on the best treatment available to them. Complementary therapies should not be used exclusively, at the expense of conventional treatment, unless significant improvements have been made and your doctor tells you otherwise.”

The article cites that researchers have halted a large, nationwide study of hormone replacement therapy after discovering that the pills now happily being taken by millions of postmenopausal women cause breast cancer, heart attacks and other serious side effects.

The absolute risk is small: Only about 1 percent of the women who took estrogen plus progesterone during the five years of the study had a problem. Nevertheless, the study authors concluded, if you’re thinking of taking HRT in hopes of preventing heart disease–don’t.

HRT is usually prescribed to treat hot flashes and other symptoms of menopause and to prevent osteoporosis, and doctors said it’s still appropriate for those purposes. But the study shows it would not be justified for long-term use in a woman with mild or no symptoms whose rationale for taking it was to improve her overall health.

The chances of this study being contradicted in a few months by another piece of research are slim: This was a huge, well-designed, well-controlled clinical trial in which 16,000 healthy postmenopausal women from all over the country were randomly assigned to take HRT or a placebo.

The results were so clear that the directors of the Women’s Health Initiative of the National Institutes of Health halted their study because of the risk to participants.

“This is as close as we’re ever going to get to a definitive study,” said Dr. Linda Hughey Holt of the Northwestern University School of Medicine, a gynecological consultant to the Women’s Health Initiative.

The study, published in the July 17 issue of the Journal of the American Medical Association, was planned to run three more years. It was halted early when it became clear the risks of long-term combined HRT outweighed the benefits.

According to the study, if 10,000 women took the drugs for one year, the group would have a total of seven more heart attacks, eight more strokes, eight more blood clots and eight more cases of breast cancer than a comparable group who were not taking the pills.

The group of women would also have six fewer cases of colon cancer and five fewer hip fractures.

Risks increase

Although the numbers might seem small, the relative risk of getting ill increases significantly with the drugs.

A woman taking the drugs increases her risk of heart disease 29 percent; of stroke, 41 percent; and of breast cancer, 26 percent.

As word of the study got out Tuesday morning, doctors were besieged by calls from concerned patients. Dr. Lauren Streicher, a gynecologist at Northwestern Memorial Hospital, said her practice received about 100 calls.

Streicher said she prepared a written response, which she e-mailed or faxed to her patients, “because I couldn’t call 100 women back in one day.”

In principal, Streicher said, women who are taking hormones just for cardiac protection should stop. But she said they should see how they feel and then make a decision about long-term use.

“If you go off your medication and find you can’t have sex, you can’t sleep and you’re miserable–then, clearly, you’re better off on it,” she said.

Like many other Chicago-area women Tuesday, Maryann Clark said she was in “quite a dilemma.”

Clark, 63, a former nurse who now manages a downtown medical practice, has been on combination HRT for 13 years, since she began suffering the night sweats and mood changes of menopause.

“I had no family history of breast cancer,” said Clark, “so I was eager to go on it. And I’ve been extremely comfortable ever since.”

Clark said she plans to talk to her gynecologist as well as to the physicians she works with before deciding what to do. But right now she’s leaning toward going off her pills and seeing what happens.

“If all those symptoms come back,” she added, “I’m probably going to take the risk, because quality of life at my age is more important.”

Holt said she has treated “a string of desperate women who were taken off their hormones by well-meaning doctors and told it was dangerous to continue. They’re miserable. Their quality of life isn’t as good.”

She said she advises long-term users that they don’t have to quit cold turkey — “we could pull their dose down or taper them off.”

`Real progress’

As unpleasant as Tuesday’s news was for many women, Holt called it “an example of real progress in medical knowledge.”

“Initially, this drug came out for hot flashes,” she said. “Then it emerged, from observation, that the women who were taking it were having fewer bone fractures and fewer heart attacks. But we didn’t know if that was because of the drug or something else.”

Research in the 1970s and ’80s established that estrogen really does help prevent bone loss and osteoporosis. But it wasn’t until the 1990s that hormones were subjected to truly rigorous scientific review to find out whether they were heart-protective.

The Women’s Health Initiative started enrolling women in 1993 to answer that question, among others. On Tuesday, it announced it had the answer.

Not only do hormones not prevent heart disease, as the earlier observational studies had suggested; they actually increase the risk, albeit only slightly.

“This is the study we’ve been waiting for,” said Dr. Matthew Sorrentino, a cardiologist at the University of Chicago.

The study that was halted was testing Prempro, the most common combination hormone pill in the U.S., with 6 million women currently taking it. A separate study, still under way, is testing Premarin (estrogen alone) in women who have undergone hysterectomy, or surgical removal of their uterus.

Premarin has been helping women over the symptoms of menopause — and making many of them feel younger and happier — for 60 years. Some 20 years ago, it was shown to increase the risk of tumors in the endometrial lining of the uterus. Since then, women who still have an intact uterus are usually given Prempro, or some other combination of estrogen and progesterone, which neutralizes the excess risk of uterine cancer.

In the Premarin study, there is no evidence so far that the risks outweigh the benefits. There is also no indication that estrogen alone causes an increased risk of breast cancer, according to Dr. Leslie Ford of the National Cancer Institute, one of the collaborators in the study.

One limitation of the newly released Prempro study was that it evaluated only one form of progesterone. Some doctors said newer types of the hormone, at lower doses, may not be as harmful.

But Ford said: “The onus is on [the manufacturers of the newer drugs] to prove they’re safe. It’s likely these results will extend to other preparations. The hormones are basically the same.”

Sorrentino, the cardiologist, said there was some reason to believe the new drugs might be better, “but we shouldn’t just guess. A formal study should be put together to prove it.”

In an editorial accompanying the results of the Prempro study in JAMA, Dr. Suzanne Fletcher of Harvard noted that approximately 38 percent of postmenopausal women in the U.S. use hormone replacement therapy.

Calling the results of the study “unexpected and disquieting,” Fletcher said doctors should explain to their patients that the absolute risk posed to an individual patient by HRT is small. Nevertheless, “risks from the drug add up over time.”

“The whole purpose of healthy women taking long-term [combined HRT] is to preserve health and prevent disease,” she concluded. “The results of this study provide strong evidence that the opposite is happening for important aspects of women’s health, even if the absolute risk is low. Given these results, we recommend that clinicians stop prescribing this combination for long-term use.”